Whether the petitioner's affidavit or declaration in support of a motion to proceed in forma pauperis satisfies the legal requirements

No question identified. : AFFIDAVIT OR DECLARATION IN SUPPORT OF MOTION FOR LEAVE TO PROCEED IN FORMA PAUPERIS I, Timothy Calhoun #495713, am the petitioner in the above-entitled case. In support of my motion to proceed in forma pauperis, I state that because of my poverty I am unable to pay the costs of this case or to give security therefor, and I believe I am entitled to redress. 1. For both you and your spouse estimate the average amount of money received from each of the following sources during the past 12 months. Adjust any amount that was received weekly, biweekly, quarterly, semiannually, or annually to show the monthly rate. Use gross amounts, that is, amounts before any deductions for taxes or otherwise. Income source Average monthly amount during Amount expected the past 12 months next month ‘You Spouse You Spouse Employment $0 $0 $0 $0 Self-employment $0 $0 $0 $0 (Hobby Shop) Income from real property $0 $0 $0 $0 (such as rental income) Interest and dividends $0 $0 $0 $0 Gifts $0 $0 $0 $0 Alimony $0 $0 $0 $0 Child Support $0 $0 $0 $0 Retirement (such as social $0 $0 $0 $0 security, pensions, annuities, insurance) Disability (such as social $0 $0 $0 $0 security, insurance payments) Unemployment payments $0 $0 $0 $0 Public-assistance $0 $0 $0 $0 (such as welfare) Other (specifiy): N/A $0 $0 $0 $0 Total monthly income: $0 $0 $0 $0 Timothy #495713\__forma pauperls u.s.s.ct...odt Timothy Cathoun y. Darrel Vannoy, Warden 2. 2. List your employment history for the past two years, most recent first. (Gross monthly pay is before taxes or other deductions.): Incarcerated Employer Address Dates of Gross monthly pay Employment N/A N/A NWA $0 —_— eee a , re — ee — $ 3. List your spouse’s employment history for the past two years, most recent employer first. (Gross monthly pay is before taxes or other deductions.) Employer Address Dates of Gross monthly pay Employment NA NWA NA $0 —_— —_ eT $_ _— ——— a ee 4. How much cash do you and your spouse have? $0 Below, state any money you or your spouse have in bank accounts or in any other financial institution. Financial institution Type of account Amount you have Amount your spouse has NA NWA $0 $0 ee a $e SL _ a rr 5. List the assets, and their values, which you own or your spouse owns. Do not list clothing and ordinary household furnishings. [ ] Home { ] Other real estate Value N/A Value N/A [ ] Motor Vehicle #1 { ] Motar Vehicle #2 Year, make & model N/A Year, make & model N/A Value N/A Value N/A [ ] Other assets Description N/A Value N/A Timothy Cathaun v. Darrel Vannoy, Warden 3. 6. State every person, business, or organization awing you or your spouse money, and the amount owed. Person owing you or Amount owed to you Amount owed to your spouse your spouse money N/A $0 $0 — $e $0 pitt $0 $s Is State the persona who rely on you or your spouse for support. Name Relationship Age NWA N/A 8. Estimate the average monthly expenses of you and your family. Show separately the amounts paid by your spouse. Adjust any payments that are made weekly, biweekly, quarterly, or annually to show the monthly rate. You Your spouse Rent or home-mortgage payment $0 $0 (included lot rented for mobile home) Are real estate taxes include? [ ] Yes[ ] No Is property insurance included? [ ] Yes[ ] No Utilities (electricity, heating fuel, water, sewer, and telephone) $0 $0 Home maintenance (repairs and upkeep) $0 $0 Food $0 $0 Clothing $0 $0 Laundry and dry-cleaning $0 $0 Medical and dental expenses $0 $0 Timothy #4957 13\__forma pauperis u.s.s.ct,..odt Tymothy Calhoun v. Darrel Vannoy, Warden 4. You Your spouse Transportation (not including motor vehicle payments) $0 $0 Recreation, entertainment, newspapers, magazines, etc. $0 $0 Insurance (not deducted from wages or included in mortgage payments) Homeowner’s or renter’s $0 $0 Life $0 $0 Health $0 $0 Motor Vehicle $0 $0 Other: N/A $0 $0 Taxes (not deducted from wages or included in mortgage payments) (specify): N/A $0 $0 Installment payments Motor Ve